Electrophysiological changes of asymptomatic carpal tunnel syndrome in patients with rheumatoid arthritis : frequency distribution and correlation to disease-related factors

Abstract EN

Background : rheumatoid Arthritis (RA) is a chronic systemic inflammatory disease characterized by chronic symmetrical and erosive arthritis with various extra articular manifestations.

Of main neurological manifestations of RA is carpal tunnel syndrome CTS.

Objective : to explore the frequency of asymptomatic CTS in patients with RA and relationships to various RA-related factors.

Methods: In this cross sectional case controlled study, fifty consecutive patients with Rheumatoid arthritis were studied at Rheumatologic−Rehabilitation and Neurophysiological departments in Marjan teaching hospital in Hilla city.

The study was conducted in the period from January to August 2011.

Thirty two healthy individuals, age and gender matched, were included in the study as control.

Both patients and control groups had no clinical evidence of carpal tunnel syndrome.

Thorough medical history, comprehensive physical examination and nerve conduction study (NCS) of median nerve for CTS were done for both patients and control.

Serologic, acute inflammatory response tests, radiographic studies were done for patients.

Results: Seventeen patients (34 %) all of them were females, were found to have electrophysiological evidence for CTS, versus one female in control group (3%).

Asymptomatic CTS was found more prevalent in patients with positive family history of RA, prolonged morning stiffness and duration of the disease, polyarticular joint involvement, wrist swelling and deformity, restriction of wrist movement, prolonged delay in the initiation of Disease Modifying Anti Rheumatic Drugs (DMARDs) therapy, patients with severe RA according to DAS-28, positive CRP, high ESR, positive RF and positive Anti-CCP antibodies and joint erosion.

Conclusion: Asymptomatic CTS is a common neurological manifestations of RA (34%), exclusively in female gender with severe disease profiles.

Therefore, NCS is essential in RA for detection of asymptomatic CTS.